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Psychosis and Antipsychotic Drugs: Overview01:28

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The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
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Antipsychotic Drugs: Therapeutic Uses and Side Effects01:21

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Antipsychotic drugs primarily block dopamine and serotonin receptors and cholinergic, adrenergic, and histaminergic receptors, thereby reducing hallucinations and delusions in conditions like schizophrenia. However, they can trigger unwanted extrapyramidal effects such as dystonias, Parkinson-like symptoms, and tardive dyskinesia.
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Antipsychotic drugs are classified into first-generation (typical) drugs including phenothiazines; and second-generation (atypical) drugs. Chlorpromazine hydrochloride (Thorazine), a phenothiazine derivative, broadly impacts the central, autonomic, and endocrine systems. This drug, along with typical agents like haloperidol (Haldol), primarily works by antagonizing D2 receptors, thus reducing dopaminergic neurotransmission. However, typical antipsychotics can cause side effects such as sedation...
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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Using antipsychotics for behavioral problems in children.

Samreen Shafiq1, Tamara Pringsheim2

  • 1a Clinical Pharmacist and Research Assistant, Mathison Centre for Mental Health Research & Education , University of Calgary , Calgary , Canada.

Expert Opinion on Pharmacotherapy
|August 14, 2018
PubMed
Summary

Second and third-generation antipsychotics show short-term efficacy for irritability in autism spectrum disorder (ASD) and disruptive behavior disorders (DBD). However, risks of adverse effects necessitate careful use alongside behavioral therapies.

Keywords:
Atypical antipsychoticsadolescentsaggressionaripiprazoleautism spectrum disorderchildrenconduct disorderdisruptive behavior disordersirritabilitylurasidoneoppositional defiant disorderquetiapinerisperidone

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Area of Science:

  • Child and Adolescent Psychiatry
  • Neurodevelopmental Disorders
  • Pharmacology

Background:

  • Antipsychotic medication use in children has risen significantly over the last 20 years.
  • Randomized controlled trials (RCTs) have investigated antipsychotic efficacy in autism spectrum disorder (ASD) and disruptive behavior disorders (DBD).

Purpose of the Study:

  • To systematically review RCTs of second and third-generation antipsychotics for irritability in ASD and aggressive/disruptive behavior in DBD.
  • To guide healthcare professionals in optimizing therapeutic strategies for pediatric populations with ASD and DBD.

Main Methods:

  • Systematic analysis of randomized controlled trials.
  • Evaluation of second and third-generation antipsychotics for specific behavioral symptoms in ASD and DBD.

Main Results:

  • Risperidone and aripiprazole demonstrate short-term efficacy for irritability in ASD.
  • Risperidone shows short-term efficacy for aggressive and disruptive behavior in DBD.
  • Benefits are weighed against increased risks of metabolic, hormonal, and extrapyramidal adverse effects.

Conclusions:

  • Antipsychotic use in children with ASD and DBD should be reserved for treatment-refractory cases with persistent, serious risks of harm.
  • These medications should be considered a short-term adjunct to ongoing psychosocial and behavioral therapies.